Journal Article
. 2021 Jul; 7:20552076211020240.
doi: 10.1177/20552076211020240.

Diagnostic digital pathology implementation: Learning from the digital health experience

Samar Betmouni 1 
Affiliations
  • PMID: 34211723
  •     55 References

Abstract

Digital Pathology (also referred to as Telepathology and Whole Slide Imaging) is the process of producing high resolution digital images from tissue sections on glass slides. These glass slides are normally examined under a microscope by a pathologist as part of the diagnostic process. The emergence of digital pathology now means that digital images are stored on secure servers and can be viewed on computer monitors; enabling pathologists to work remotely and to collaborate with other colleagues when second opinions are needed. The implementation of digital pathology into clinical practice has many potential benefits. Although this has been long recognised, its adoption as a diagnostic tool remains low and pathologists' projections about its future deployment are cautious. Notable early digital pathology adopters have led the way. The challenge now is to scale-up digital pathology beyond the relatively few large networks and centres of excellence. Many other areas of healthcare have accumulated experience about optimising approaches to digital health/healthcare technology deployment and sustainability. This has been done in a multi-disciplinary context and has applied theoretical/conceptual frameworks. Thus far there has been little use of similar frameworks in the planning of digital pathology deployment in clinical practice. In this essay, I will explore the scope of digital pathology implementation approaches that have been deployed in clinical practice and examine what can be learned from the wider healthcare experience of adopting, scaling-up and sustaining innovative healthcare solutions.

Keywords: Digital pathology; diagnostics; implementation; pathology; telepathology; theoretical frameworks; whole slide imaging.

Can artificial intelligence help create racial equality in the USA?
The Lancet Digital Health.
Lancet Digit Health, 2021 Feb 13; 3(3). PMID: 33574001
Towards a global strategy on digital health.
Bernardo Mariano.
Bull World Health Organ, 2020 Apr 15; 98(4). PMID: 32284641    Free PMC article.
The effects of a regional telepathology project: a study protocol.
Marie-Claude Trudel, Guy Paré, Bernard Têtu, Claude Sicotte.
BMC Health Serv Res, 2012 Mar 17; 12. PMID: 22420301    Free PMC article.
Implementation of large-scale routine diagnostics using whole slide imaging in Sweden: Digital pathology experiences 2006-2013.
Sten Thorstenson, Jesper Molin, Claes Lundström.
J Pathol Inform, 2014 May 21; 5(1). PMID: 24843825    Free PMC article.
Why business modeling is crucial in the development of eHealth technologies.
Maarten van Limburg, Julia E W C van Gemert-Pijnen, +3 authors, Erwin R Seydel.
J Med Internet Res, 2011 Dec 30; 13(4). PMID: 22204896    Free PMC article.
Review.
Trends in the US and Canadian Pathologist Workforces From 2007 to 2017.
David M Metter, Terence J Colgan, +2 authors, Jason Y Park.
JAMA Netw Open, 2019 Jun 01; 2(5). PMID: 31150073    Free PMC article.
Future-proofing pathology: the case for clinical adoption of digital pathology.
Bethany Jill Williams, David Bottoms, Darren Treanor.
J Clin Pathol, 2017 Aug 07; 70(12). PMID: 28780514
Review.
Best practices in scaling digital health in low and middle income countries.
Alain B Labrique, Christina Wadhwani, +4 authors, Ann Aerts.
Global Health, 2018 Nov 06; 14(1). PMID: 30390686    Free PMC article.
Review.
An Essential Pathology Package for Low- and Middle-Income Countries.
Kenneth A Fleming, Mahendra Naidoo, +9 authors, Nestor Lago.
Am J Clin Pathol, 2017 Feb 06; 147(1). PMID: 28158414
Preconceived Stakeholders' Attitude Toward Telepathology: Implications for Successful Implementation.
Elahe Gozali, Reza Safdari, +5 authors, Bahlol Rahimi.
J Pathol Inform, 2018 Feb 09; 8. PMID: 29416913    Free PMC article.
Implementation of Whole Slide Imaging for Clinical Purposes: Issues to Consider From the Perspective of Early Adopters.
Andrew J Evans, Mohamed E Salama, Walter H Henricks, Liron Pantanowitz.
Arch Pathol Lab Med, 2017 Apr 26; 141(7). PMID: 28440660
Review.
Being fully digital: perspective of a Dutch academic pathology laboratory.
Nikolas Stathonikos, Tri Q Nguyen, +2 authors, Paul J van Diest.
Histopathology, 2019 Jul 14; 75(5). PMID: 31301690    Free PMC article.
Review.
Adoption of routine telemedicine in Norwegian hospitals: progress over 5 years.
Paolo Zanaboni, Richard Wootton.
BMC Health Serv Res, 2016 Sep 21; 16. PMID: 27644324    Free PMC article.
A nationwide telepathology consultation and quality control program in China: implementation and result analysis.
Je Chen, Yahui Jiao, +3 authors, Chen Zhou.
Diagn Pathol, 2015 Jan 08; 9 Suppl 1. PMID: 25565398    Free PMC article.
Implementation of digital pathology into diagnostic practice: perceptions and opinions of histopathology trainees and implications for training.
Lisa Browning, Richard Colling, +3 authors, Clare Verrill.
J Clin Pathol, 2019 Oct 11; 73(4). PMID: 31597682
Telepathology Impacts and Implementation Challenges: A Scoping Review.
Julien Meyer, Guy Paré.
Arch Pathol Lab Med, 2015 Dec 01; 139(12). PMID: 26619028
Review.
Determinants of successful telemedicine implementations: a literature study.
Tom H F Broens, Rianne M H A Huis in't Veld, +3 authors, Lambert J M Nieuwenhuis.
J Telemed Telecare, 2007 Sep 06; 13(6). PMID: 17785027
Review.
Needs and workflow assessment prior to implementation of a digital pathology infrastructure for the US Air Force Medical Service.
Jonhan Ho, Orly Aridor, +10 authors, Anil V Parwani.
J Pathol Inform, 2014 Jan 07; 4. PMID: 24392246    Free PMC article.
Routine Digital Pathology Workflow: The Catania Experience.
Filippo Fraggetta, Salvatore Garozzo, +2 authors, Esther Diana Rossi.
J Pathol Inform, 2018 Feb 09; 8. PMID: 29416914    Free PMC article.
Telepathology in Low Resource African Settings.
Nnamdi Orah, Olorunda Rotimi.
Front Public Health, 2019 Oct 02; 7. PMID: 31572705    Free PMC article.
Validation of a whole-slide image-based teleconsultation network.
Alexi Baidoshvili, Nikolas Stathonikos, +7 authors, Paul J van Diest.
Histopathology, 2018 Jun 13; 73(5). PMID: 29893996
The Challenges of a Complex and Innovative Telehealth Project: A Qualitative Evaluation of the Eastern Quebec Telepathology Network.
Hassane Alami, Jean-Paul Fortin, +3 authors, France Tanguay.
Int J Health Policy Manag, 2018 May 17; 7(5). PMID: 29764106    Free PMC article.
Implementation Strategies to Enhance the Implementation of eHealth Programs for Patients With Chronic Illnesses: Realist Systematic Review.
Cecilie Varsi, Lise Solberg Nes, +10 authors, Hilde Eide.
J Med Internet Res, 2019 Oct 02; 21(9). PMID: 31573934    Free PMC article.
Systematic Review.
Grand challenges in digital health.
Patty Kostkova.
Front Public Health, 2015 May 23; 3. PMID: 26000272    Free PMC article.
Use of contextual inquiry to understand anatomic pathology workflow: Implications for digital pathology adoption.
Jonhan Ho, Orly Aridor, Anil V Parwani.
J Pathol Inform, 2012 Dec 18; 3. PMID: 23243553    Free PMC article.
Digital pathology and artificial intelligence.
Muhammad Khalid Khan Niazi, Anil V Parwani, Metin N Gurcan.
Lancet Oncol, 2019 May 03; 20(5). PMID: 31044723
Highly Cited. Review.
Evaluating the benefits of digital pathology implementation: time savings in laboratory logistics.
Alexi Baidoshvili, Anca Bucur, +3 authors, Paul J van Diest.
Histopathology, 2018 Jun 21; 73(5). PMID: 29924891
Implementation of Digital Pathology Offers Clinical and Operational Increase in Efficiency and Cost Savings.
Matthew G Hanna, Victor E Reuter, +9 authors, S Joseph Sirintrapun.
Arch Pathol Lab Med, 2019 Jun 08; 143(12). PMID: 31173528    Free PMC article.
A Practical Guide to Whole Slide Imaging: A White Paper From the Digital Pathology Association.
Mark D Zarella, Douglas Bowman, +6 authors, Douglas J Hartman.
Arch Pathol Lab Med, 2018 Oct 12; 143(2). PMID: 30307746
Highly Cited. Review.
Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update).
Jamie Ross, Fiona Stevenson, Rosa Lau, Elizabeth Murray.
Implement Sci, 2016 Oct 27; 11(1). PMID: 27782832    Free PMC article.
Highly Cited. Systematic Review.
Telepathology networking in VISN-12 of the Veterans Health Administration.
B E Dunn, H Choi, +2 authors, C W Davis.
Telemed J E Health, 2000 Dec 08; 6(3). PMID: 11110638
Next generation diagnostic pathology: use of digital pathology and artificial intelligence tools to augment a pathological diagnosis.
Anil V Parwani.
Diagn Pathol, 2019 Dec 29; 14(1). PMID: 31881972    Free PMC article.
Providing Pathology Support in Low-Income Countries.
Shahin Sayed, Robert Lukande, Kenneth A Fleming.
J Glob Oncol, 2015 Sep 23; 1(1). PMID: 28804765    Free PMC article.
Invention and Early History of Telepathology (1985-2000).
Ronald S Weinstein, Michael J Holcomb, Elizabeth A Krupinski.
J Pathol Inform, 2019 Feb 21; 10. PMID: 30783545    Free PMC article.
Review.
Complete Digital Pathology for Routine Histopathology Diagnosis in a Multicenter Hospital Network.
Juan Antonio Retamero, Jose Aneiros-Fernandez, Raimundo G Del Moral.
Arch Pathol Lab Med, 2019 Jul 12; 144(2). PMID: 31295015
Digital pathology access and usage in the UK: results from a national survey on behalf of the National Cancer Research Institute's CM-Path initiative.
Bethany Jill Williams, Jessica Lee, Karin A Oien, Darren Treanor.
J Clin Pathol, 2018 Jan 11; 71(5). PMID: 29317516    Free PMC article.
Role of digital pathology in diagnostic histopathology in the response to COVID-19: results from a survey of experience in a UK tertiary referral hospital.
Lisa Browning, Eve Fryer, +4 authors, Clare Verrill.
J Clin Pathol, 2020 Jul 04; 74(2). PMID: 32616541    Free PMC article.
New beginnings.
The Lancet Digital Health.
Lancet Digit Health, 2020 Dec 18; 2(1). PMID: 33328032
Combined robotic and nonrobotic telepathology as an integral service component of a geographically dispersed laboratory network.
B E Dunn, H Choi, U A Almagro, D L Recla.
Hum Pathol, 2002 Jan 05; 32(12). PMID: 11774160
Artificial intelligence in digital pathology: a roadmap to routine use in clinical practice.
Richard Colling, Helen Pitman, +6 authors, Clare Verrill.
J Pathol, 2019 May 31; 249(2). PMID: 31144302
Review.
Telepathology for effective healthcare in developing nations.
Smita Sankaye, Sushil Kachewar.
Australas Med J, 2011 Jan 01; 4(11). PMID: 23386872    Free PMC article.
Home telehealth uptake and continued use among heart failure and chronic obstructive pulmonary disease patients: a systematic review.
Sarah L Gorst, Christopher J Armitage, Simon Brownsell, Mark S Hawley.
Ann Behav Med, 2014 Apr 26; 48(3). PMID: 24763972    Free PMC article.
Systematic Review.
On the Edge of a Digital Pathology Transformation: Views from a Cellular Pathology Laboratory Focus Group.
Casmir Turnquist, Sharon Roberts-Gant, +5 authors, Clare Verrill.
J Pathol Inform, 2020 Jan 04; 10. PMID: 31897354    Free PMC article.
A systematic review on the implementation of eHealth interventions for informal caregivers of people with dementia.
Hannah L Christie, Sara L Bartels, +3 authors, Marjolein E de Vugt.
Internet Interv, 2018 Sep 13; 13. PMID: 30206519    Free PMC article.
Review.
Implementation of whole slide imaging in surgical pathology: A value added approach.
Mike Isaacs, Jochen K Lennerz, +3 authors, John D Pfeifer.
J Pathol Inform, 2011 Oct 05; 2. PMID: 21969920    Free PMC article.
Diffusion of telemedicine: a knowledge barrier perspective.
H Tanriverdi, C S Iacono.
Telemed J, 2000 Jul 25; 5(3). PMID: 10908437
Understanding the dispensary workflow at the Birmingham Free Clinic: a proposed framework for an informatics intervention.
Arielle M Fisher, Mary I Herbert, Gerald P Douglas.
BMC Health Serv Res, 2016 Feb 20; 16. PMID: 26892780    Free PMC article.
Enterprise Implementation of Digital Pathology: Feasibility, Challenges, and Opportunities.
D J Hartman, L Pantanowitz, +3 authors, G R Lauro.
J Digit Imaging, 2017 Jan 25; 30(5). PMID: 28116576    Free PMC article.
Telemedicine: challenges and opportunities.
Anthony C Smith.
Expert Rev Med Devices, 2006 Dec 26; 4(1). PMID: 17187466
Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies.
Trisha Greenhalgh, Joseph Wherton, +7 authors, Sara Shaw.
J Med Internet Res, 2017 Nov 03; 19(11). PMID: 29092808    Free PMC article.
Highly Cited.
Exploring the challenges of implementing e-health: a protocol for an update of a systematic review of reviews.
Jamie Ross, Fiona Stevenson, Rosa Lau, Elizabeth Murray.
BMJ Open, 2015 Apr 15; 5(4). PMID: 25869685    Free PMC article.
The history of pathology informatics: A global perspective.
Seung Park, Anil V Parwani, +15 authors, Liron Pantanowitz.
J Pathol Inform, 2013 Jul 23; 4. PMID: 23869286    Free PMC article.
Why does the NHS struggle to adopt eHealth innovations? A review of macro, meso and micro factors.
Sheena Asthana, Ray Jones, Rod Sheaff.
BMC Health Serv Res, 2019 Dec 23; 19(1). PMID: 31864370    Free PMC article.
Review.
The Development of a Methodology for Contextual User Research in Healthcare Design Projects.
Donal Healion, Enda O'Dowd, Sam Russell.
Stud Health Technol Inform, 2018 Oct 30; 256. PMID: 30371480
Going fully digital: Perspective of a Dutch academic pathology lab.
Nikolas Stathonikos, Mitko Veta, André Huisman, Paul J van Diest.
J Pathol Inform, 2013 Jul 17; 4. PMID: 23858390    Free PMC article.